Radical antegrade modular pancreatosplenectomy procedure for adenocarcinoma of the body and tall of the pancreas: Ability to obtain negative tangential margins

BACKGROUND: Positive resection margins and low lymph node counts are common in resections of cancers of the body and tail of the pancreas. In 2003, we described a novel approach for resection of the pancreas called radical antegrade modular pancreatosplenectomy (RAMPS), which was directed toward these problems. We now present results of treatment of patients with adenocarcinoma using RAMPS with particular reference to the ability of this procedure to obtain negative tangential margin rates. STUDY DESIGN: Data from 23 patients treated with RAMPS procedure were collected in a prospective database. Data from the operative notes, pathology reports, and postoperative data were entered into the database. RESULTS: Mean (+/- SD) operative time was 6.3 (+/- 1.8) hours. Fifteen patients had anterior RAMPS procedure and eight posterior RAMPS procedure. There were no postoperative (30 days) or hospital deaths. Eighteen postoperative complications developed in 12 of 23 (52%) patients. Mean tumor size was 5.1 cm. Invasion outside the pancreatic capsule was identified in 78% of patients. Median number of nodes was 15. Ninety-one percent had negative tangential margins, which is the main finding of the study. Median survival was 21 months. The 5-year overall survival is 26%, but followup is still short. CONCLUSIONS: RAMPS procedure can achieve negative tangential margins in a high percent of patients with resectable carcinoma of the body and tail of the pancreas. Median and overall survival rates are quite satisfactory for this tumor and are similar to rates reported for the Whipple procedure.